I have a rare GI disease that requirs central venous access. Because
of the number of placements, thrombosis, infection etc, the
traditional placements in the subclavian and jugular can no longer be
used.  I must have CVP access and I want to know what alternatives are
available.  I also have superior vena cava thrombosis syndrom.

Hello -


This page gives a nice overview of the sites used for central venous
access, and also has a brief discussion of why certain sites are used
and the complications that can ensue (including clotting off of
vessels):
http://www.venousaccess.com/CME%20pages/Access%20site%20anatomy.htm

Hickman catheters are most often placed in the jugular or subclavian
veins due the relative ease of insertion without much danger to
surrounding structures.  Other veins are available for central venous
access, but usually are approached by an interventional radiologist
(they would also be accesible in an open, surgical procedure, but it
would be a much bigger deal).  Such sites include:

trans-hepatic inferior vena cava
lumbar approach to the vena cava
intercostal vein

One description of central venous access (including the above
mentioned sites):
http://www.emedicine.com/radio/topic859.htm

A case report of a patient with clots in both his superior and
inferior venous systems (subclavians and femorals) who was accessed
through both trans-hepatic (although, the complication this patient
had - fungal infection - is by no means common) and intercostal vein
access:
http://www.scvir.org/members/caseclub/1197/1197_04/1197_04.htm

Central venous access is usually obtained through the upper
extremities, but the lower extremities also offer a few sites,
although the femoral vein (in the groin) is by far the most common. 
Some surgeons and interventional radiologists will consider placement
of long-term catheters in the femoral vein.

A nice overview from an interventional radiology site about central
access:
http://www.healthsystem.virginia.edu/internet/radiology/angio/central-venous-access.cfm#Whatsites

Peripherally inserted central catheters (PICC - not to be confused
with PIC which is just a peripherally inserted catheter) can also be
an option depending on the status of the peripheral vessels and the
cental vessels to which they connect - your history of superior vena
cava thrombosis syndrome probably rules out use of upper extremity
veins however, and PICC lines are not as commonly used in the legs in
adults, but are possible.

A brief description of the procedure for insertion in the femoral
vein:
http://www.barttersite.com/PICCchildren.htm


I would suggest that you mention the possibility of an interventional
radiology consult to your treating physician to evaluate central
venous access options not available through other means.  There may be
other reasons why they would not wish to place such a device now, such
as current infection (almost noone wishes to place an implantable
device is someone with an ongoing infection, the risk of the bacteria
colonizing the implant is much too high) or coagulation status (ie if
your blood is not clotting well, they may wish to hold off).

A nice review of the current state of practice regarding central
venous catheter access.  Unfortunately, only the abstract is available
free online:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=21091295

As a personal note, I have had great success with patients having
alternative central access through these means - although, every case
is individual and only your treating physicians will be able to help
you select the most appropriate route of access for you.

Let me know if you have further questions.

synarchy

Google searches:
non-traditional central access
hickman central access
hickman femoral
PICC femoral

Thank you for providing  valuable liks as well as articles regarding
cv lines for people who have the type of problems people like I have. 
Though there were 2 web sites I had not explored there was only one
procedure new to me.  that one new procedure may make a a huge
differencen for me What I am most grateful for is the contact names
provided in the answers.  Those have made a special difference.  I
believe there is hope for me after all!  Again many thanks.  Bobbie